At The Intersection of Grief and Depression, A Controversy

Is grief a mental illness? A top medical journal questions the move to classify grief as depression.

Grief over the loss of a loved one has typically been considered as different from depression, although it can share many of the same symptoms: sadness, crying spells, loss of appetite, and the inability to concentrate. The source of a grieving person's depressed mood has been viewed as connected with a clearly-identifiable sad event; while for people who were depressed, the source of sadness was generally less clear-cut.

Now, the authors of the new revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) have proposed that bereavement should not necessarily be excluded before diagnosing a person with depression. The move has proved to be quite controversial.

The British medical journal, The Lancet has published an editorial and a piece by Arthur Kleinman, taking the position that classifying grief as a form of depression would be a bad idea. Kleinman, the Esther and Sidney Rabb Professor of Anthropology and Professor of Medical Anthropology in the Faculty of Medicine at Harvard University, was moved to write his piece based on his own experience of grief: he lost his wife less than a year ago.

After his wife died, he said it took six months before his grief became less intense. He still feels sad at times, he said.

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'Doctors would do better to offer time, compassion, remembrance, and empathy, than pills.'

The view has been, and the Lancet editors and Kleinman seem to agree, that grief is actually a very natural psychological – and perhaps, biological – response, which might be best left alone. The proposed shift in the DSM means that people suffering from grief could be diagnosed with depression, and perhaps treated for it pharmaceutically.

Turning grief into a medical issue – medicalizing it – could be dangerous, since there is no precedent for treating grief with medication. “The evidence base for treating recently bereaved people with standard antidepressant regimens is absent," the Lancet editors write.

Not only are there no data to suggest that grief might be helped by antidepressants, there are no data to suggest that it should be. In fact, the “grief reaction” is arguably a natural part of loss that should not be extinguished with pharmaceuticals. Antidepressants used to “treat” grief would not necessarily help a person process his or her emotions any better.

There is a point, however, long recognized by the DSM and mental health professionals, when grief can go on for too long and become unhealthy, or turn into true clinical depression. As such times medication and therapy can help one is better able to cope with and move beyond them.

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Grief can clearly be difficult on the body and mind, The Lancet concludes, but “for those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy, than pills.” Luckily, there is still time for revisions before the DSM-V is published next year; hopefully a consensus can be reached before then.

The editorial and Kleinman's essay are published in the February 18, 2012 online issue of The Lancet and are available, free, to the public.